DPP-4 inhibitors (Gliptins)

00:01 The sixth family are the DPP-4 inhibitors; the gliptins.

00:06 Okay.

00:07 So, here's how this works.

00:09 Glucagon is a hormone that increases glucose production in the liver, okay? Your pancreas puts out both glucagon and insulin, so if that was not really familiar to you, make sure you write yourself a note, "Pancreas secretes glucagon and insulin.” They do opposite things.

00:27 Remember, insulin takes glucose out of the blood stream, puts it in the cells so blood sugar lowers.

00:34 Glucagon's job is to stimulate glucose production from the liver, so your blood sugar will rise.

00:41 We're talking about the gliptins, and sitagliptin is the one we're looking at.

00:45 Now, incretins are hormones that stimulate the release of insulin when glucose is present.

00:50 So, incretins are the hormones, they're the messengers, that when your blood sugar is rising and there's glucose present, it will suppress glucagon because, hey, when my blood sugar is rising, I don't need the liver to make any more sugar.

01:06 So, your blood sugar will be lowered.

01:09 DPP-4 is a hormone that inactivates incretin, so your blood sugar level will be lower, maybe even normal, but it will definitely be lower.

01:21 Now, that may have seemed like a lot of a process to go through.

01:24 So, what I want you to do is to pause the video, and walk back through your pictures till you're sure that you're clear on this mechanism of action.

01:40 Okay.

01:40 Back with us? So, DPP-4 inhibitors block the breakdown of incretin, they increase the release of insulin, and they suppress the release of glucagon.

01:51 That's why your blood sugar is lower because it blocks the incretin from being broken down, that way, I have more insulin available, that'll lower my blood sugar, and less glucagon that will also cause a lower blood sugar.

02:05 So, this improves your A1C, your hemoglobin A1C, by about 0.5%, so that might be really helpful, depending on where your patient is.

02:14 So, don't think that's not good enough.

02:17 That's really kind of helpful to drop that A1C by 0.5% just by adding a medication.

02:24 So, we might give this medication in monotherapy, by itself, or we might give it in combination.

02:30 Okay, we put a giant pancreas with the big triangle in it to remind you that this drug, the gliptins, can have a rare side effect of pancreatitis.

02:40 So, particularly, sitagliptin, can have this rare side effect.

02:44 I know that it's rare, but because it can end up being life-threatening, I wanted to make sure you brought this to your attention.

02:50 So, it can range from mild, which mild pancreatitis is really uncomfortable for your patient, but it could progress to life-threatening, so it's really important that you recognize the early signs and symptoms of pancreatitis, so you can teach your patients.

03:05 Early signs would be intractable nausea, that means I have some pretty severe nausea that doesn't seem to resolve.

03:12 They have severe abdominal pain, they could have some vomiting.

03:15 This is when they need to contact their healthcare provider immediately, and not take an additional dose of the medication.